Will Evidence-Based Medicine Become Reality?

Pills and surgery are potent symbols of healing power, but our faith in these symbols has often blinded us to truths. Somewhere along the line, theory trumped reality. Administering a medicine or performing a surgery became more important than its effect. (from NY Times story)

Did you ever think about the fact that your physician might not be using evidence-based medicine? This is an interesting discussion topic since we know it takes years for research and information to be disseminated throughout the medical community and become the standard of practice.

Scientific knowledge about best care is not applied systematically or expeditiously to clinical practice. It now takes an average of 17 years for new knowledge generated by randomized controlled trails to be incorporated into practice, and even then application is highly uneven. (According to the Institute of Medicine)

Will that change? One would think so. With technology, you can see more and more tools being used by the physician. You can also see more and more companies doing things like claims editing and then using clinical edits to support the process essentially creating the safety net for the physician, the consumer, and the payer. By implementing clinical standards from places like NCCN or using clinical pathways, companies can help physicians to drive better outcomes at lower costs. This is key for us to manage our healthcare costs here in the US and eliminate unwarranted variation.

Evidence-based medicine (EBM) or evidence-based practice (EBP) aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments (including lack of treatment) and diagnostic tests. This helps clinicians to learn whether or not any treatment will do more good than harm.

Evidence quality can be assessed based on the source type (from meta-analyses and systematic reviews of double-blind, placebo-controlled clinical trials at the top end, down to conventional wisdom at the bottom), as well as other factors including statistical validity, clinical relevance, currency, and peer-review acceptance.

EBM/EBP recognizes that many aspects of health care depend on individual factors such as quality- and value-of-life judgments, which are only partially subject to scientific methods. EBP, however, seeks to clarify those parts of medical practice that are in principle subject to scientific methods and to apply these methods to ensure the best prediction of outcomes in medical treatment, even as debate continues about which outcomes are desirable.

So, there is certainly some debate about this becoming “cookie-cutter” and not being personalized to the individual patient, but I think that’s a common misnomer. EBM is a tool to help guide care to the best decisions based on research and data, but it is balanced with the physician-patient relationship and specific needs.

[BTW – Another aspect of this is enabling consumers with information about how to select locations that are low-cost given the variety in pricing which exists. There was an article in the USA Today about this recently.]

2 Responses to “Will Evidence-Based Medicine Become Reality?”

it is very important to realize that the best approach for the patient is not necessary the cheapest,. A lot of tests currently performed might not be necessary or not proven to be useful but this approach could also proof that more expensive tests could be better. So sure, it is the right approach for the patient but maybe not for our wallet.

Also remember that we are dealing with human values and not statistics, 6 months of great life is it better than 2 years in agonizing pain or saving the life of 60% of patient is it better than extending the life of 10 years of 80% of the patient?

this is just one part of the equation, the reduction of the number of tests, not the reduction of their individual cost.

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